P413 Screening and diagnosis of Candidemia in adult hematological malignancies of northern India

Abstract

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PMCandidemia is caused by Candida species which has become a common cause of fungal infection in the bloodstream infection throughout the world. In hematological malignancies, patients have a high rate of morbidity and mortality due to Candidemia.AimTo identify Candidemia in immunocompromised patients with the help of various conventional methods as well as automated methods for early detection and treatment.Material and MethodsThis study was conducted from 2018 to 2021. In this study, we enrolled immunocompromised patients with hematological malignancies. For early diagnosis of Candidemia we did conventional method as well as PCR. Compare the conventional, automated, and PCR methods for diagnosis of Candidemia and was performed antifungal susceptibility testing for treatment in hematological patients.ResultsTotal 187 patients were enrolled on the basis of febrile neutropenia. A total of 125/187 males (66.8%) and 62/187 females (33.2%) participated in the present study followed by age range from 10 to 77 years (mean = 33.16, standard deviation = 16.29). A total of 5 patients (2.6%) were positive from blood culture, and 9 patients (4.8%) were positive from PCR. In 4 patients of AML C. tropicalis was (3; 1.60%) and C. auris (1; 0.5%) followed by 1 patient with pancytopenia C. tropicalis (1; 0.5%). The sensitivity was done according to the Clinical Laboratory Standards Institute (CLSI) guideline M27-A3 reference document for C. tropicalis (4), and C. auris (1). A total of 4 isolates of C. tropicalis were sensitive to drug VRC (MIC range 0.125 μg/ml), AMP (MIC range 1 μg/ml), FLU (MIC range 1 μg/ml), CAS (MIC range 0.25 μg/ml) and 1 resistant pattern toward FLU (MIC range 4 μg/ml). Candida auris was resistant toward AMP (MIC range 2 μg/ml), FLU (MIC range 64 μg/ml), and sensitive toward CAS (MIC range 0.5 μg/mL). A total of 4 isolates of C. tropicalis was sensitive for drug VRC (80%), AMP (80%), FLU (60%), CAS (80%), and resistant pattern for FLU (20%). Candida auris was resistant toward AMP (20%), FLU (20%), and sensitive toward CAS (20%). In all, 9/187 patients’ blood was positive for fungal infection, primer NL-1 and NL-4 were able to amplify the D1/D2 region of 28S r-DNA of large ribosomal subunit which target rDNA yielding Product of PCR give 600 bp related to all fungus. Primer P4501 and P4502 identify the P-450 lanosterol 14α-demethylase gene which is target Candida species genes single band of around 350 bp. Mannan antigen of Candida was performed by ELISA method for diagnosis of candidemia in hematological patients.ConclusionThis present observational study recognizes the main association of Candidemia with hematological malignancies. We try to develop PCR and automated methods in routine mycology laboratory to diagnose Candidemia in an early stage in hematological malignancies along with other immunocompromised patients for better treatment to cure the disease.